主页 > 医学前沿 >
【medical-news】药物洗脱支架与裸支架三年死亡率
Methods: Using data from a prospective multicentre registry, we compared rates of death and of death or repeat revascularization during 3 years of follow-up of 6440 consecutive patients who underwent angioplasty with either drug-eluting or bare-metal stents between Apr. 1, 2003, and Mar. 31, 2006.
Results: Drug-eluting stents were inserted in 1120 patients and bare-metal stents in 5320. The drug-eluting stents were selected for patients who had a greater burden of comorbid illness, including diabetes mellitus (32.8% v. 20.8% in the bare-metal group, p < 0.001) and renal disease (7.4% v. 5.0%, p = 0.001). At 1-year follow-up, the drug-eluting stents were associated with a mortality of 3.0%, as compared with 3.7% with the bare-metal stents (adjusted odds ratio [OR] 0.62, 95% confidence interval [CI] 0.46–0.83). The rate of the composite outcome of death or repeat revascularization was 12.0% for the drugeluting stents and 15.8% for the bare-metal stents (adjusted OR 0.40, 95% CI 0.33–0.49). In the subgroup of patients who had acute coronary syndromes, the adjusted OR for this composite outcome was 0.46 (95% CI 0.35–0.61). During the 3 years of observation, the relative risks for death and repeat revascularization varied over time. In year 1, there was an initial period of lower risk in the group with drug-eluting stents than in the group with bare-metal stents; this was followed by a shift toward outcome rates favouring bare-metal stents in years 2 and 3. The adjusted relative risk of the composite outcome of death or repeat revascularization associated with drugeluting stents relative to bare-metal stents was 0.73 early in the first year of follow-up; it then rose gradually over time, to a peak of 2.24 at 3 years.
Interpretation: Drug-eluting stents are safe and effective in the first year following insertion. Thereafter, the possibility of longer term adverse events cannot be ruled out. 原文出处:
Philpott AC, Southern DA, Clement FM, et al. Long-term outcomes of patients receiving drug-eluting stents. CMAJ 2009; DOI:10.1503/cmaj.080050.
Available at: http://www.cmaj.ca.
原文链接：
cmaj.080050v1.pdf (428.98k) 本人已认领该文编译，48小时后若未提交译文，请其他战友自由认领 Background: We sought to establish the long-term safety of drug-eluting stents compared with bare-metal stents in a usual care setting.
背景：探讨药物洗脱支架与金属裸支架在常规医疗措施下的长期安全性的比较。
Methods: Using data from a prospective multicentre registry, we compared rates of death and of death or repeat revascularization during 3 years of follow-up of 6440 consecutive patients who underwent angioplasty with either drug-eluting or bare-metal stents between Apr. 1, 2003, and Mar. 31, 2006.
方法：通过对多中心的数据进行前瞻性研究，通过对自2003年4月1日至2006年3月31日行血管介入置入药物洗脱支架或是金属裸支架的6440名患者进行为期3年的随访。比较两组患者死亡率、再次血管成形术的死亡率或需再次血管成形术的复发率
Results: Drug-eluting stents were inserted in 1120 patients and bare-metal stents in 5320. The drug-eluting stents were selected for patients who had a greater burden of comorbid illness, including diabetes mellitus (32.8% v. 20.8% in the bare-metal group, p < 0.001) and renal disease (7.4% v. 5.0%, p = 0.001).At 1-year follow-up, the drug-eluting stents were associated with a mortality of 3.0%, as compared with 3.7% with the bare-metal stents (adjusted odds ratio [OR] 0.62, 95% confidence interval [CI] 0.46–0.83). The rate of the composite outcome of death or repeat revascularization was 12.0% for the drugeluting stents and 15.8% for the bare-metal stents (adjusted OR 0.40, 95% CI 0.33–0.49). In the subgroup of patients who had acute coronary syndromes, the adjusted OR for this composite outcome was 0.46 (95% CI 0.35–0.61). During the 3 years of observation, the relative risks for death and repeat revascularization varied over time. In year 1, there was an initial period of lower risk in the group with drug-eluting stents than in the group with bare-metal stents; this was followed by a shift toward outcome rates favouring bare-metal stents in years 2 and 3. The adjusted relative risk of the composite outcome of death or repeat revascularization associated with drugeluting stents relative to bare-metal stents was 0.73 early in the first year of follow-up; it then rose gradually over time, to a peak of 2.24 at 3 years.
。
结果：1120名患者置入药物洗脱支架，5320名患者置入金属裸支架。药物洗脱支架被选择性置入有严重合并症的患者，包括糖尿病(32.8% 相对应 20.8%的患者接受了金属裸支架, p < 0.001)和肾脏疾病(7.4% 相对5.0%, p = 0.001)。在1年的随访期内，置入药物涂布支架的患者死亡率为3.0%，而置入裸支架的患者死亡率为3.7%（修正危害系数[OR] 0.62, 95%可信区间[CI] 0.46–0.83）。药物洗脱支架的死亡率或再次血管成形术发生率两者相加为12.0%，而置入金属裸支架的患者的比率为15.8%（修正危害系数[OR] 0.40, 95%可信区间[CI] 0.33–0.49）。在合并急性冠脉综合症的患者中，混合结果的修正危害比为0.46 (95% CI 0.35–0.61)。在3年的观察期内，死亡和再次血管成形术的危险因素随着时间变化而有所不同。在第1年，初始阶段，药物洗脱支架人群的危险性要低于裸支架；而在第2年和第3年，结果显示金属裸支架则更加有优势。在随访的第1年，与药物洗脱支架相关的死亡率或再次血管成形率相对于金属裸支架相关的死亡率或再次血管成形率之比为0.73。而随着时间发展，比值逐渐增加，在第3年达到峰值2.24。
阅读本文的人还阅读：
作者:admin@医学,生命科学 2011-09-17 06:33
医学,生命科学网